Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 396
Filter
1.
Article in English | WPRIM | ID: wpr-880675

ABSTRACT

Magnetic resonance imaging (MRI) is a very important imaging method for diagnosis and treatment of prostate cancer (PCa) in clinical practice. As functional MRI is growing and maturing, its quantitative parameters are expected to enhance the clinical value of MRI furtherly. Intravoxel incoherent motion diffusion imaging, diffusion tensor imaging, and diffusion kurtosis imaging, which were derived from diffusion weighted imaging, have provided richer and more accurate parameters. The newly-developed magnetic resonance elastography can complement the mechanical characteristics of PCa.


Subject(s)
Diffusion Magnetic Resonance Imaging , Diffusion Tensor Imaging , Humans , Magnetic Resonance Imaging , Male , Motion , Prostatic Neoplasms/diagnostic imaging
2.
Article in Chinese | WPRIM | ID: wpr-879282

ABSTRACT

Diffusion tensor imaging technology can provide information on the white matter of the brain, which can be used to explore changes in brain tissue structure, but it lacks the specific description of the microstructure information of brain tissue. The neurite orientation dispersion and density imaging make up for its shortcomings. But in order to accurately estimate the brain microstructure, a large number of diffusion gradients are needed, and the calculation is complex and time-consuming through maximum likelihood fitting. Therefore, this paper proposes a kind of microstructure parameters estimation method based on the proximal gradient network, which further avoids the classic fitting paradigm. The method can accurately estimate the parameters while reducing the number of diffusion gradients, and achieve the purpose of imaging quality better than the neurite orientation dispersion and density imaging model and accelerated microstructure imaging via convex optimization model.


Subject(s)
Brain/diagnostic imaging , Diffusion Magnetic Resonance Imaging , Diffusion Tensor Imaging , Neurites , White Matter
4.
National Journal of Andrology ; (12): 881-887, 2020.
Article in Chinese | WPRIM | ID: wpr-880286

ABSTRACT

Objective@#To investigate the relationship between the apparent diffusion coefficient (ADC) histogram parameters based on the whole tumor and the pathological grade and lymph node metastasis (LNM) of PCa.@*METHODS@#This retrospective study included 82 cases of PCa confirmed pathologically and subjected to MRI preoperatively. We obtained a series of ADC histogram parameters, such as ADCmean, ADCmedian, ADC25%, ADC75%, entropy, and histogram width, by processing the ADC images via the Firevoxel Post-Processing and the SPSS24 software. We compared the parameters between the high-risk and low- or moderate-risk groups as well as between the LNM-positive and LNM-negative groups of the patients, and analyzed the diagnostic performance of the parameters with statistically significant differences.@*RESULTS@#The high-risk group, compared with the low- or moderate-risk one, showed a significantly lower ADCmean ([590 ± 120] vs [837 ± 142] ×10-6 mm2/s, P < 0.01), ADCmedian ([560 ± 117] vs [804 ± 139] ×10-6 mm2/s, P < 0.01), ADC25% ([446.5 ± 98] vs [717 ± 118] ×10-6 mm2/, P < 0.01) and ADC75% ([667 ± 132] vs [931 ± 167] ×10-6 mm2/s, P < 0.01). The ADCmean manifested the highest diagnostic performance, with an AUC of 0.907, a sensitivity of 0.933 and a specificity of 0.796. No statistically significant difference was found between the high-risk and the low- or moderate-risk one in entropy (3.58 ± 0.39 vs 3.63 ± 0.42, P = 0.238) or the histogram width ([540 ± 73] vs [520 ± 65] ×10-6 mm2/s, P = 0.086). Both entropy and the histogram width were remarkably higher in the LNM-positive than in the LNM-negative group (3.95 ± 0.41 vs 3.12 ± 0.45, P < 0.01; [578 ± 59] vs [455 ± 68] ×10-6 mm2/s, P < 0.01), and the former had an even higher diagnostic performance, with an AUC of 0.836, a sensitivity of 0.887 and a specificity of 0.781. There were no statistically significant differences between the LNM-positive and LNM-negative groups in the ADCmean ([768 ± 135] vs [790±128] ×10-6 mm2/s, P = 0.402), ADCmedian ([759 ± 110] vs [775 ± 121] ×10-6 mm2/s, P = 0.225), ADC25% ([643 ± 91] vs [657 ± 89] ×10-6 mm2/s, P = 0.654) or ADC75% ([895 ± 127] vs [872 ± 129] ×10-6 mm2/s, P = 0.926).@*CONCLUSIONS@#ADC histogram parameters are related to pathological grade and LNM of PCa, and the analysis of the ADC histogram based on the whole tumor has an important value for preoperative evaluation and prognostic estimation of the malignancy.


Subject(s)
Diffusion Magnetic Resonance Imaging , Humans , Lymphatic Metastasis , Male , Prognosis , Prostatic Neoplasms/pathology , Retrospective Studies
5.
Article in Chinese | WPRIM | ID: wpr-828945

ABSTRACT

Diffusion-weighted imaging (DWI) is currently the most sensitive technique to diagnose early ischemic stroke. DWI signal hyperintensity is usually considered to suggest irreversible infarct core, but recent studies demonstrated that DWI hyperintensity signal could be reversible on small embolic lesions. Herein we present a case in a 63-year-old male patient, who was admitted to the emergency department with altered mental status and complaint of weakness in the left arm and leg 6.8 h prior to the admission. Emergency cranial magnetic resonance imaging (MRI) and angiography (MRA) revealed occlusion of his right middle cerebral artery (MCA) and large lesions on DWI. The patient underwent intra-artery thrombectomy after evaluation in spite of the large volume of the DWI lesions up to 91.5 mL at the baseline. His right MCA was recanalized at 8.5 h from symptom onset. One week after the procedure, the patient showed reduced DWI lesion volume to 11.58 mL. In this case we observed the reversibility of a large lesion of the anterior artery circulation presenting with hyperintensity on DWI, suggesting that the clinical implication of DWI hyperintensity should be interpreted with caution, and a large volume of baseline DWI hyperintensity may not be a contraindication to thrombectomy. This conclusion, however, awaits further validation by future large-scale randomized controlled trials.


Subject(s)
Diffusion Magnetic Resonance Imaging , Humans , Infarction, Middle Cerebral Artery , Diagnostic Imaging , Magnetic Resonance Imaging , Male , Middle Aged , Stroke , Thrombectomy
6.
Article in Chinese | WPRIM | ID: wpr-828679

ABSTRACT

OBJECTIVE@#To study the value of fractional anisotropy (FA) of regions of interest (ROI) on magnetic resonance diffusion tensor imaging (DTI) in bilirubin-induced neurological dysfunction in neonates.@*METHODS@#A total of 91 neonates with hyperbilirubinemia who were hospitalized from January 2017 to January 2018 were enrolled. According to the peak level of total serum bilirubin, they were divided into three groups: mild/moderate increase (n=45), severe increase (n=35), and extremely severe increase (n=11). According to the presence or absence of abnormal neurological manifestations, they were divided into two groups: neurological dysfunction (n=20) and non-neurological dysfunction (n=71). Ten healthy full-term infants were enrolled as the control group. Head DTI was performed for all neonates to measure the FA values of the bilateral globus pallidus, the anterior limb of the internal capsule, the posterior limb of the internal capsule, and the cerebellar dentate nucleus.@*RESULTS@#The extremely severe increase group had significantly lower FA values of the globus pallidus than the control, mild/moderate increase, and severe increase groups (P<0.05). The severe increase group had significantly lower FA values of the globus pallidus than the control group (P<0.05). The extremely severe increase group had significantly lower FA values of the posterior limb of the internal capsule than the control, mild/moderate increase, and severe increase groups (P<0.05). The neurological dysfunction group had significantly lower FA values of the globus pallidus and the posterior limb of the internal capsule than the non-neurological dysfunction group (P<0.05).@*CONCLUSIONS@#Serum bilirubin level combined with the changes in the DTI FA values of the globus pallidus and the posterior limb of the internal capsule can be used to predict the injury of cerebral nuclei and white matter fibers.


Subject(s)
Anisotropy , Bilirubin , Brain , Diffusion Magnetic Resonance Imaging , Diffusion Tensor Imaging , Humans , Infant, Newborn , Magnetic Resonance Imaging , Magnetic Resonance Spectroscopy , White Matter
7.
Article in Chinese | WPRIM | ID: wpr-826389

ABSTRACT

To prospectively evaluate the correlation between intravoxel incoherent motion (IVIM)-derived parameters and CT perfusion parameters as well as the pathological grade in insulinoma. A total of 55 patients with suspected insulinoma undergoing IVIM and CT perfusion scans were prospectively enrolled. The images were post-processed to obtain IVIM parameters including apparent diffusion coefficient (ADC),diffusion (D),perfusion correlated diffusion (D*),and f,and CT perfusion parameters including blood flow (BF),blood volume (BV),and permeability (PM). The pathological specimens were stained to obtain pathological parameters including the grading,ki-67 index,and the mitotic count. The IVIM derived parameters of normal pancreas including head,body,and tail as well as that of the pancreatic insulinoma were compared. The correlation between IVIM parameters and CT perfusion parameters as well as the pathological parameters was analyzed. ADC and D values of pancreatic tail were significantly lower than those of the pancreatic head and neck (all 0.05). IVIM parameters differ at different anatomical parts of normal pancreas. IVIM parameters can distinguish normal pancreatic parenchyma from insulinoma. The ADC value is weakly correlated with BF.


Subject(s)
Diffusion Magnetic Resonance Imaging , Humans , Insulinoma , Diagnostic Imaging , Motion , Pancreatic Neoplasms , Diagnostic Imaging , Reproducibility of Results , Tomography, X-Ray Computed
8.
Article in Chinese | WPRIM | ID: wpr-826387

ABSTRACT

To compare the differences in apparent diffusion coefficient (ADC) and fractional anisotropy (FA) between brucella spondylitis (BS) groups at different stages before treatment and the normal control group and to evaluate the change trend of ADC value and FA value at different time points before and after treatment. Totally 53 patients suspected of BS by conventional magnetic resonance imaging (MRI) and later confirmed as BS patients by serological tests were enrolled in this study. These patients underwent conventional MRI and diffusion tensor imaging scans,and the ADC value and FA value were measured. Independent sample test was used to compare the ADC value and FA value between the BS group and the control group,the ADC value and FA value between the BS group at each stage. Repeated measurement ANOV was used to compare the ADC values and FA values at different time points before and after treatment. FA imaging showed that the color code of BS was different from that of the normal control group,and the color code of FA imaging showed increased singal. The ADC values of BS in the acute,subacute,and chronic stages [(1.45±0.02)×10 mm /s,(1.35±0.03)×10 mm /s,(1.26±0.05)×10 mm /s,respectively] were significantly higher than those in the control group [(1.06±0.09) ×10 mm /s](=2.538,=0.009;=1.998,=0.032;=1.575,=0.004),and the FA value (0.55±0.02,0.65±0.03,0.71±0.04,respectively) were significantly lower than those of the control group (0.78±0.02) (=2.440,=0.012; =1.847,=0.041;=2.102,=0.003). Repeated measurement analysis showed that there were statistically significant differences in ADC values and FA values at different time points before and after treatment in the acute,subacute,and chronic stages (ADC:=12.100,<0.001;=8.439,=0.005;=9.704,=0.004,respectively;FA:=7.080,=0.002;=6.607;=0.003;=8.868,=0.001,respectively). The ADC values at different time points after treatment were significantly lower than those before treatment or at a previous time point after treatment (=332.14,<0.001),and the FA values were significantly higher than those before treatment or at a previous time point after treatment (=134.26,<0.001). FA color code can intuitively display differences in BS and normal vertebral bodies and show change of color code before and after treatment. Also,the ADC values and FA values can quantitatively reveal differences between BS and normal vertebral body in different time points and quantify BS vertebral lesion changes before and after treatment. In particular,in BS patients who are recovering from treatment,it can quantify microscopic edema. Therefore,diffusion tensor imaging may be useful objective indicator in evaluating the effectiveness of a specific treatment for BS.


Subject(s)
Anisotropy , Brucella , Brucellosis , Diagnostic Imaging , Diffusion Magnetic Resonance Imaging , Diffusion Tensor Imaging , Humans , Spondylitis , Diagnostic Imaging , Microbiology
9.
Article in Chinese | WPRIM | ID: wpr-826345

ABSTRACT

We reported a case of supratentorial primary central nervous system lymphoma with hyperperfusion.Computed tomography revealed hyperdense lesions on the bilateral centrum semiovale with obvious edema.Magnetic resonance imaging demonstrated that the lesion presented slightly long and iso-T1 signal and slightly long and long T2 signals;hyperintensity was found on diffusion-weighted imaging,with relatively high apparent diffusion coefficient value compared with the adjacent normal white matter.Contrast-enhanced imaging revealed bilateral evenly enhanced lesions,along with patchy non-enhanced shadows in right-sided lesion.The perfusion-weighted imaging revealed hyperperfusion in bilateral lesions.


Subject(s)
Central Nervous System Neoplasms , Diffusion Magnetic Resonance Imaging , Humans , Lymphoma , Magnetic Resonance Imaging
10.
Article in Chinese | WPRIM | ID: wpr-826341

ABSTRACT

To explore the utility of apparent diffusion coefficient(ADC)histogram analysis for differentiating genetic subtypes of diffuse lower-grade gliomas. A total of 55 patients with WHO grade Ⅱ/Ⅲ diffuse lower-grade gliomas who underwent preoperative routine brain magnetic resonance imaging and diffusion weighted imaging in our center were retrospectively evaluated.Among whom there were 14 patients with isocitrate dehydrogenase(IDH)wild-type gliomas(IDH group),19 patients with IDH-mutant 1p19q intact gliomas(IDH 1p19q group),and 22 patients with IDH-mutant 1p19q co-deleted gliomas(IDH 1p19q group).The whole-lesion ADC values derived from histogram analysis(including ADC,ADC,ADC5%,ADC10%,ADC25%,ADC50%,ADC75%,ADC90%,ADC95%,ADC,mode,range,skewness,kurtosis,standard deviation,inhomogeneity,and entrophy)were measured for each patient.All parameters between the different genetic subtypes were compared by using the Student's test or Mann-Whitney test.Receiver operating curve(ROC)analysis was used to assess the diagnostic performance of ADC histogram in distinguishing the different genetic subtypes. Compared with IDH group,the ADC75%(=0.021),ADC90%(=0.015),ADC95%(=0.014),ADC (=0.035),range(=0.009),standard deviation(=0.001)and inhomogeneity(=0.001)were significantly lower in IDH group;in contrast,the ADC (=0.031)and kurtosis(=0.020)of IDH group were significantly higher than those in IDH group.The ADC(=0.010),ADC5%(=0.016),ADC10%(=0.012),ADC25%(=0.007),ADC50%(=0.005),ADC75%(=0.015),and mode(=0.002)were significantly higher in IDH 1p19q group than in IDH 1p19q group.Inhomogeneity achieved the highest area under ROC(AUC)(0.811)in differentiating IDH gliomas and IDH gliomas,with a cutoff value of 0.229;the sensitivity and specificity were 85.7% and 73.2%.The mode achieved the highest AUC(0.744)in differentiating IDH 1p19q gliomas and IDH 1p19q gliomas,with a cutoff value was 1448.75×10 mm /s;the sensitivity and specificity were 57.9% and 90.9%. ADC histograms analysis may be helpful to differentiate genetic subtypes in lower-grade gliomas.


Subject(s)
Brain Neoplasms , Diffusion Magnetic Resonance Imaging , Glioma , Humans , ROC Curve , Retrospective Studies
11.
Chinese Medical Journal ; (24): 2653-2659, 2020.
Article in English | WPRIM | ID: wpr-877873

ABSTRACT

BACKGROUND@#Liver fibrosis (LF) continues to develop and eventually progresses to cirrhosis. However, LF and early-stage cirrhosis (ESC) can be reversed in some cases, while advanced cirrhosis is almost impossible to cure. Advances in quantitative imaging techniques have made it possible to replace the gold standard biopsy method with non-invasive imaging, such as radiomics. Therefore, the purpose of this study is to develop a radiomics model to identify LF and ESC.@*METHODS@#Patients with LF (n = 108) and ESC (n = 116) were enrolled in this study. As a control, patients with healthy livers were involved in the study (n = 145). Diffusion-weighted imaging (DWI) data sets with three b-values (0, 400, and 800 s/mm) of enrolled cases were collected in this study. Then, radiomics features were extracted from manually delineated volumes of interest. Two modeling strategies were performed after univariate analysis and feature selection. Finally, an optimal model was determined by the receiver operating characteristic area under the curve (AUC).@*RESULTS@#The optimal models were built in plan 1. For model 1 in plan 1, the AUCs of the training and validation cohorts were 0.973 (95% confidence interval [CI] 0.946-1.000) and 0.948 (95% CI 0.903-0.993), respectively. For model 2 in plan 1, the AUCs of the training and validation cohorts were 0.944, 95% CI 0.905 to 0.983, and 0.968, 95% CI 0.940 to 0.996, respectively.@*CONCLUSIONS@#Radiomics analysis of DWI images allows for accurate identification of LF and ESC, and the non-invasive biomarkers extracted from the functional DWI images can serve as a better alternative to biopsy.


Subject(s)
Diffusion Magnetic Resonance Imaging , Humans , Liver Cirrhosis/diagnostic imaging , Machine Learning , ROC Curve , Retrospective Studies
12.
Chinese Medical Journal ; (24): 2403-2409, 2020.
Article in English | WPRIM | ID: wpr-877850

ABSTRACT

BACKGROUND@#Due to development of magnetic resonance-based functional imaging, it is easier to detect micro-structural alterations of tumor tissues. The aim of this study was to conduct a preliminary evaluation of the correlation of non-Gaussian diffusion kurtosis imaging (DKI) parameters with expression of molecular markers (epidermal growth factor receptor [EGFR]; anaplastic lymphoma kinase [ALK]; Ki-67 protein) in patients with advanced lung adenocarcinoma, using routine diffusion-weighted imaging as the reference standard.@*METHODS@#Data from patients with primary lung adenocarcinoma diagnosed at Cancer Hospital, Chinese Academy of Medical Sciences (CHCAMS) from 2016 to 2019 were collected for retrospective analysis. The pathologic and magnetic resonance imaging data of 96 patients who met the inclusion criteria were included in this study. Specifically, the Kapp and Dapp parameters measured from the DKI model; apparent diffusion coefficient (ADC) value from the diffusion-weighted imaging model; and the EGFR, ALK, and Ki-67 biomarkers detected by immunohistochemistry and/or molecular biology techniques after biopsy or surgery were evaluated. The relations between quantitative parameters (ADC, Kapp, Dapp) and pathologic outcomes (EGFR, ALK, and Ki-67 expression) were analyzed by Spearman correlation test.@*RESULTS@#Of the 96 lung adenocarcinoma lesions (from 96 patients), the number of EGFR- and ALK-positive and high Ki-67 expressing lesions were 53, 12, and 83, respectively. The Kapp values were significantly higher among patients with EGFR-positive mutations (0.81 ± 0.12 vs. 0.66 ± 0.10, t = 6.41, P < 0.001), ALK rearrangement-negative (0.76 ± 0.12 vs. 0.60 ± 0.15, t = 4.09, P < 0.001), and high Ki-67 proliferative index (PI) (0.76 ± 0.12 vs. 0.58 ± 0.13, t = 4.88, P < 0.001). The Dapp values were significantly lower among patients with high Ki-67 PI (3.19 ± 0.69 μm/ms vs. 4.20 ± 0.83 μm/ms, t = 4.80, P < 0.001) and EGFR-positive mutations (3.11 ± 0.73 μm/ms vs. 3.59 ± 0.77 μm/ms, t = 3.12, P = 0.002). The differences in mean Dapp (3.73 ± 1.26 μm/ms vs. 3.26 ± 0.68 μm/ms, t = 1.96, P = 0.053) or ADC values ([1.34 ± 0.81] × 10 mm/s vs. [1.33 ± 0.41] × 10 mm/s, t = 0.07, P = 0.941) between the groups with or without ALK rearrangements were not statistically significant. The ADC values were significantly lower among patients with EGFR-positive mutation ([1.19 ± 0.37] × 10 mm/s vs. [1.50 ± 0.53] × 10 mm/s, t = 3.38, P = 0.001) and high Ki-67 PI ([1.28 ± 0.39] × 10 mm/s vs. [1.67 ± 0.77] × 10 mm/s, t = 2.88, P = 0.005). Kapp was strongly positively correlated with EGFR mutations (r = 0.844, P = 0.008), strongly positively correlated with Ki-67 PI (r = 0.882, P = 0.001), and strongly negatively correlated with ALK rearrangements (r = -0.772, P = 0.001). Dapp was moderately correlated with EGFR mutations (r = -0.650, P = 0.024) or Ki-67 PI (r = -0.734, P = 0.012). ADC was moderately correlated with Ki-67 PI (r = -0.679, P = 0.033).@*CONCLUSIONS@#The Kapp value of DKI parameters was strongly correlated with different expression of EGFR, ALK, and Ki-67 in advanced lung adenocarcinoma. The results potentially indicate a surrogate measure of the status of different molecular markers assessed by non-invasive imaging tools.


Subject(s)
Adenocarcinoma of Lung/genetics , Diffusion Magnetic Resonance Imaging , Humans , Lung Neoplasms/genetics , Reproducibility of Results , Retrospective Studies
13.
Coluna/Columna ; 18(4): 289-293, Oct.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1055990

ABSTRACT

ABSTRACT Objective: The role of diffusion-weighted MRI in differential diagnostics and predicting the survival of patients with spine metastases was studied. Methods: The study included data from MRI and morphological studies of 23 patients with spine metastases. Results: The values obtained for the apparent diffusion coefficient (ADC) of tumors were compared with their histological type, cell density and Ki-67 proliferation index. The effect of ADC values on overall patient survival was also assessed. A reliable inverse correlation was established between ADC values and Ki-67 proliferation index for various types of spine metastases (r=-0.753, p=0.017). The dependence of ADC values and overall survival of patients with metastases in the spine is shown. Conclusion: The technique of diffusion-weighted MRI can be used as part of a comprehensive assessment in the preoperative planning of surgical treatment, and as a prognostic factor of overall survival for this group of patients. Level of Evidence II. Prognostic retrospective study,


RESUMO Objetivos: O papel da RM ponderada por difusão nos diagnósticos diferenciais e na previsão da sobrevida dos pacientes com metástases da coluna vertebral foram analisados. Métodos: O estudo incluiu dados da RM e estudos morfológicos de 23 pacientes com metástases da coluna vertebral. Resultados: Os valores obtidos para o coeficiente de difusão aparente (ADC) dos tumores foram comparados com seu tipo histológico, densidade celular e índice de proliferação Ki-67. Além disso, avaliou-se o efeito dos valores de ADC na sobrevida global dos pacientes. Foi estabelecida uma correlação inversa confiável entre os valores de ADC e o índice de proliferação Ki-67 para diversos tipos de metástases da coluna vertebral (r =-0,753, p=0,017). A dependência dos valores de ADC e a sobrevida global dos pacientes com metástases na coluna vertebral é demostrada. Conclusão: A técnica da RM ponderada por difusão pode ser utilizada como parte de uma avaliação abrangente do planejamento pré-operatório do tratamento cirúrgico e como fator prognóstico da sobrevida global para esse grupo de pacientes. Nível de Evidência II. Estudo retrospectivo prognóstico.


RESUMEN Objetivos: Fueron analizados el papel de la RM ponderada por difusión en los diagnósticos diferenciales y en la previsión de la sobrevida de los pacientes con metástasis de la columna vertebral. Métodos: El estudio incluyó datos de RM y estudios morfológicos de 23 pacientes con metástasis de la columna vertebral. Resultados: Los valores obtenidos para el coeficiente de difusión aparente (ADC) de los tumores se compararon con su tipo histológico, densidad celular e índice de proliferación Ki-67. Además, se evaluó el efecto de los valores de ADC en la sobrevida global de los pacientes. Se estableció una correlación inversa confiable entre los valores de ADC y el índice de proliferación Ki-67 para diversos tipos de metástasis de la columna vertebral (r =-0,753, p=0,017). Es demostrada la dependencia de los valores de ADC y la sobrevida global de los pacientes con metástasis en la columna vertebral. Conclusión: La técnica de RM ponderada por difusión puede utilizarse como parte de una evaluación integral de la planificación preoperatoria del tratamiento quirúrgico y como un factor pronóstico de la sobrevida global para este grupo de pacientes. Nivel de Evidencia II. Estudio retrospectivo pronóstico.


Subject(s)
Humans , Spine , Survival , Diffusion Magnetic Resonance Imaging , Cell Proliferation , Neoplasm Metastasis
15.
J. bras. nefrol ; 41(3): 436-439, July-Sept. 2019. graf
Article in English | LILACS | ID: biblio-1040244

ABSTRACT

Abstract Introduction: The posterior reversible encephalopathy (PRES) syndrome encompasses a set of clinical-radiological findings associated with severe systemic arterial hypertension. This case report proposes to discuss the identification, diagnosis, and management of PRES in the pediatric population. Case presentation: Female patient, 10 years old, admitted to the emergency room with complaint of oliguria and generalized edema. At the initial physical exam, the only alteration present was anasarca. The diagnostic investigation revealed nephrotic syndrome, and clinical treatment was started. She evolved on the 8th day of hospitalization with peak hypertension, sudden visual loss, reduced level of consciousness, nystagmus, and focal seizures requiring intubation. She was transferred to the Intensive Care Unit, with neurological improvement, after the established therapy. CT scan revealed a discrete hypodense area in the white matter of the occipital lobe and anteroposterior groove asymmetry, compatible with PRES. Discussion: PRES is due to vasogenic cerebral edema of acute or subacute installation. Symptoms include headache and altered consciousness, stupor, coma, neurological deficits, seizures and cortical blindness. Nephropathies are the main cause of PRES in pediatrics. Magnetic resonance imaging with diffusion of molecules is the gold standard for diagnosis. The initial treatment objectives are the reduction of blood pressure, antiepileptic therapy, correction of hydroelectrolytic and acid-base disorders and management of intracranial hypertension. Conclusion: PRES is associated with acute hypertension. Early diagnosis and proper management may determine a better prognosis and minimize the severity of the clinical course.


Resumo Introdução: A Síndrome de Encefalopatia Posterior Reversível (SEPR) engloba um conjunto de achados clínico-radiológicos, associados a hipertensão arterial sistêmica grave. Este relato de caso propõe discutir a identificação, o diagnóstico e o manejo de SEPR na população pediátrica. Apresentação do caso: Paciente do sexo feminino, 10 anos, admitida em pronto-atendimento com queixa de oligúria e edema generalizado. Ao exame físico inicial, a única alteração presente era anasarca. A investigação diagnóstica revelou síndrome nefrótica, iniciando-se tratamento clínico. Evoluiu no 8º dia de internação com pico hipertensivo, perda visual súbita, redução do nível de consciência, nistagmo e crises convulsivas focais, demandando intubação. Foi transferida para Unidade de Terapia Intensiva, com melhora neurológica, após a terapêutica instituída. Tomografia de crânio evidenciou área de hipodensidade discreta em substância branca do lobo occipital e assimetria anteroposterior de sulcos, compatível com SEPR. Discussão: A SEPR decorre de edema cerebral vasogênico de instalação aguda ou subaguda. Sintomas descritos incluem cefaleia e alteração de consciência, estupor, coma, déficits neurológicos, convulsões e cegueira cortical. As nefropatias constituem as principais causas de SEPR em pediatria. A ressonância magnética com difusão de moléculas é o padrão-ouro para o diagnóstico. Os objetivos iniciais são a redução dos níveis pressóricos, terapia antiepiléptica, correção de distúrbios hidroeletrolíticos e do equilíbrio ácido-básico, e manejo da hipertensão intracraniana. Conclusão: A SEPR ocorre associada à hipertensão aguda. O diagnóstico precoce e manejo adequado podem determinar melhor prognóstico e minimizar a gravidade do curso clínico.


Subject(s)
Humans , Female , Child , Intracranial Hypertension/complications , Posterior Leukoencephalopathy Syndrome/etiology , Posterior Leukoencephalopathy Syndrome/diagnostic imaging , Hypertension/complications , Nephrotic Syndrome/complications , Tomography, X-Ray Computed , Treatment Outcome , Intracranial Hypertension/therapy , Diffusion Magnetic Resonance Imaging , Posterior Leukoencephalopathy Syndrome/drug therapy , Hypertension/drug therapy , Anticonvulsants/therapeutic use , Antihypertensive Agents/therapeutic use
16.
Article in Chinese | WPRIM | ID: wpr-774037

ABSTRACT

OBJECTIVE@#To study the value of fast spin-echo diffusion weighted imaging (TSE-DWI) apparent diffusion coefficient (ADC) in children aged 2-12 years with intellectual disability (ID)/global developmental delay (GDD) who have normal conventional brain MRI findings.@*METHODS@#A total of 578 children with normal conventional brain MRI findings who met the diagnostic criteria for ID/GDD and 375 normal children were enrolled. Their imaging and clinical data were collected. All children underwent scanning with brain TSE-DWI sequence and routine sequence. ADC values of each brain region were compared between normal children with different ages, as well as between children with different degrees of ID/GDD in each age group. The influence of Adaptive Behavior Assessment System-II (ABAS-II) score on ADC values of each brain region was analyzed.@*RESULTS@#For the normal children, the ADC values of the frontal and temporal white matter, the corpus callosum, the inner capsule, the centrum semiovale, the cerebellar dentate nucleus, the optic radiation, the thalamus, the lenticular nucleus, and the caudate nucleus gradually decreased with age (P<0.05). ADC values of the deep white matter, the shallow white matter, the deep gray matter nuclei, and the shallow gray matter increased with the increase in the degree of ID/GDD in the ID/GDD children aged 4-6 years (P<0.05). In the children with ID/GDD, the ADC values of the deep white matter, the shallow white matter, and the deep gray matter nuclei decreased with age (P<0.05). The ADC values of the children with ID/GDD decreased with the increase in ABAS-II score (P<0.05).@*CONCLUSIONS@#ADC can reflect the subtle structural changes of brain regions in children with ID/GDD who have normal conventional brain MRI findings. It may be associated with social adaptation. It can provide an objective basis for the quantitative diagnosis of ID/GDD in children.


Subject(s)
Brain , Child , Child, Preschool , Diffusion Magnetic Resonance Imaging , Humans , Intellectual Disability , Diagnostic Imaging , Magnetic Resonance Imaging , White Matter
17.
Article in English | WPRIM | ID: wpr-764184

ABSTRACT

PURPOSE: The purpose of this study was to investigate if double inversion recovery (DIR) imaging can have a role in the evaluation of brain ischemia, compared with diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) imaging. MATERIALS AND METHODS: Sixty-seven patients within 48 hours of onset, underwent MRI scans with FLAIR, DWI with b-value of 0 (B0) and 1000 s/mm², and DIR sequences. Patients were categorized into four groups: within three hours, three to six hours, six to 24 hours, and 24 to 48 hours after onset. Lesion-to-normal ratio (LNR) value was calculated and compared among all sequences within each group, by the Friedman test and conducted among all groups, for each sequence by the Kruskal-Wallis test. In qualitative assessment, signal intensity changes of DIR, B0, and FLAIR based on similarity with DWI and image quality of each sequence, were graded on a 3-point scale, respectively. Scores for detectability of lesions were compared by the McNemar's test. RESULTS: LNR values from DWI were higher than DIR, but not statistically significant in all groups (P > 0.05). LNR values of DIR were significantly higher than FLAIR within 24 hours of onset (P < 0.05). LNR values were significantly different between, before, and after six hours onset time for DIR (P = 0.016), B0 (P = 0.008), and FLAIR (P = 0.018) but not for DWI (P = 0.051). Qualitative analysis demonstrated that detectability of DIR was higher, compared to that of FLAIR within 4.5 hours and six hours of onset (P < 0.05). Also, the DWI quality score was lower than that of DIR, particularly relative to infratentorial lesions. CONCLUSION: DIR provides higher detectability of hyperacute brain ischemia than B0 and FLAIR, and does not suffer from susceptibility artifact, unlike DWI. So, DIR can be used to replace evaluation of the FLAIR-DWI mismatch.


Subject(s)
Artifacts , Brain Infarction , Brain Ischemia , Diffusion Magnetic Resonance Imaging , Humans , Magnetic Resonance Imaging , Stroke
18.
Article in English | WPRIM | ID: wpr-764171

ABSTRACT

PURPOSE: The purpose of this study was to evaluate dynamic contrast-enhanced breast magnetic resonance imaging (DCE-MRI), and diffusion-weighted imaging (DWI) variables, for axillary lymph node (ALN) metastasis in the early stage of breast cancer. MATERIALS AND METHODS: January 2011–April 2015, 787 patients with early stage of breast cancer were retrospectively reviewed. Only cases of invasive ductal carcinoma, were included in the patient population. Among them, 240 patients who underwent 3.0-T DCE-MRI, including DWI with b value 0 and 800 s/mm² were enrolled. MRI variables (adjacent vessel sign, whole-breast vascularity, initial enhancement pattern, quantitative kinetic parameters, signal enhancement ratio (SER), tumor apparent diffusion coefficient (ADC), peritumoral ADC, and peritumor-tumor ADC ratio) clinico-pathologic variables (age, T stage, multifocality, extensive intraductal carcinoma component (EIC), estrogen receptor, progesterone receptor, HER-2 status, Ki-67, molecular subtype, histologic grade, and nuclear grade) were compared between patients with axillary lymph node metastasis and those with no lymph node metastasis. Multivariate regression analysis was performed, to determine independent variables associated with ALN metastasis, and the area under the receiver operating characteristic curve (AUC), for predicting ALN metastasis was analyzed, for those variables. RESULTS: On breast MRI, moderate or prominent ipsilateral whole-breast vascularity (moderate, odds ratio [OR] 3.45, 95% confidence interval [CI] 1.28–9.51 vs. prominent, OR = 15.59, 95% CI 2.52–96.46), SER (OR = 1.68, 95% CI 1.09–2.59), and peritumor-tumor ADC ratio (OR = 6.77, 95% CI 2.41–18.99), were independently associated with ALN metastasis. Among clinico-pathologic variables, HER-2 positivity was independently associated, with ALN metastasis (OR = 23.71, 95% CI 10.50–53.54). The AUC for combining selected MRI variables and clinico-pathologic variables, was higher than that of clinico-pathologic variables (P < 0.05). CONCLUSION: SER, moderate or prominent increased whole breast vascularity, and peritumor-tumor ADC ratio on breast MRI, are valuable in predicting ALN metastasis, in patients with early stage of breast cancer.


Subject(s)
Area Under Curve , Breast Neoplasms , Breast , Carcinoma, Ductal , Carcinoma, Intraductal, Noninfiltrating , Diffusion , Diffusion Magnetic Resonance Imaging , Estrogens , Humans , Lymph Nodes , Magnetic Resonance Imaging , Neoplasm Metastasis , Odds Ratio , Receptors, Progesterone , Retrospective Studies , ROC Curve
19.
Journal of Stroke ; : 69-77, 2019.
Article in English | WPRIM | ID: wpr-740617

ABSTRACT

BACKGROUND AND PURPOSE: Thrombectomy within 24 hours can improve outcomes in selected patients with a clinical-infarct mismatch. We devised an easy-to-use visual estimation tool that allows infarct volume estimation in centers with limited resources. METHODS: We identified 1,031 patients with cardioembolic or large-artery atherosclerosis infarction on diffusion-weighted images (DWIs) obtained before recanalization therapy and within 24 hours of onset, and occlusion of the internal carotid or middle cerebral artery. Acute DWIs were mapped onto a standard template and used to create visual reference maps with known lesion volumes, which were then used in a validation study (with 130 cases) against software estimates of infarct volume. RESULTS: The DWI reference map chart comprises 144 maps corresponding to 12 different infarct volumes (0.5, 1, 2, 3, 5, 7, 9, 11, 13, 15, 17, and 19 mL) in each of 12 template slices (Montreal Neurological Institute z-axis –15 to 51 mm). Infarct volume in a patient is estimated by selecting a slice with a similar infarct size at the corresponding z-axis level on the reference maps and then adding up over all slices. The method yielded good correlations to software volumetrics and was easily learned by both experienced and junior physicians, with approximately 1 to 2 minutes spent per case. The sensitivity, specificity, and accuracy for detecting threshold infarct volumes ( 90%). CONCLUSIONS: We developed easy-to-use reference maps that allow prompt and reliable visual estimation of infarct volumes for triaging patients to thrombectomy in acute stroke.


Subject(s)
Atherosclerosis , Cerebral Infarction , Decision Making , Diffusion Magnetic Resonance Imaging , Humans , Infarction , Medical Staff, Hospital , Methods , Middle Cerebral Artery , Sensitivity and Specificity , Stroke , Thrombectomy
20.
São Paulo; s.n; 2019. 38 p. ilust, tabelas.
Thesis in Portuguese | LILACS, Inca | ID: biblio-1179701

ABSTRACT

O melanoma de coroide é o tumor intraocular primário mais comum em adultos. Por possibilitar a conservação do globo ocular, a braquiterapia tem sido uma opção terapêutica nestes casos. Atualmente, o método de imagem mais utilizado para avaliação deste tumor é a ultrassonografia ocular, auxiliando na estimativa do tamanho e localização da lesão para controle e planejamento do tratamento. No entanto, a redução nas dimensões do tumor só é observada tardiamente após o tratamento. O objetivo deste trabalho é avaliar o papel da ressonância magnética (RM) com difusão na avaliação de pacientes com melanoma de coroide, no momento do diagnóstico e na avaliação de resposta terapêutica após braquiterapia. Foi realizado um estudo prospectivo, unicêntrico, aprovado pelo Comitê de Ética em Pesquisa, que incluiu pacientes com melanoma de coroide e indicação para braquiterapia. Foram propostos três exames de RM para cada paciente, sendo um antes e dois após o tratamento. Foi realizado cálculo do valor do coeficiente de difusão aparente (ADC) nos exames de RM e comparado com o controle tumoral local avaliado pelo acompanhamento oftalmológico (mapeamento de retina e ultrassonografia ocular). No período de 07/2018 a 06/2019, 19 pacientes foram incluídos, dos quais 13 realizaram exames de acompanhamento. A idade variou de 24 a 78 anos e 52,9% eram do sexo masculino. Na ultrassonografia ocular, a espessura e diâmetro médio dos tumores foi de 6,3 mm e 11,5 mm, respectivamente. Na RM inicial, a maioria dos tumores apresentava sinal alto ou intermediário em T1 (82,3%) e baixo em T2 (70,6%). Dois pacientes (15,4%) apresentaram sinais de progressão do tumor durante o acompanhamento e foi observada redução significativa nos valores de ADC médio entre a RM antes e após o tratamento nestes casos (p=0,02). Em conclusão, a RM com difusão demonstrou ser útil na avaliação de pacientes com melanoma de coroide e os valores de ADC médio podem ser utilizados para avaliação de resposta, permitindo identificar precocemente os pacientes com risco de progressão após a braquiterapia


Choroidal melanoma is the most common primary intraocular tumor in adults. Brachytherapy has been a therapeutic option in these cases because it allows the conservation of the eyeball. Currently, the most used imaging method for the evaluation of this tumor is ocular ultrasonography, helping to estimate the size and location of the lesion for treatment planning and follow-up. However, the reduction in tumor size is only observed late after treatment. The aim of this study is to evaluate the role of diffusion-weighted magnetic resonance imaging (DW-MRI) in the evaluation of patients with choroidal melanoma at the time of diagnosis and in the evaluation of therapeutic response after brachytherapy. A prospective, unicentric study approved by the Research Ethics Committee, which included patients with choroidal melanoma and indication for brachytherapy, was performed. Three DW-MRI examinations were proposed for each patient, one before and two after treatment. The apparent diffusion coefficient (ADC) value was calculated on DW-MRI and compared with local tumor control assessed by ophthalmologic follow-up (retinal mapping and ocular ultrasound). From 07/2018 to 06/2019, 19 patients were included, of which 13 underwent follow-up examinations. Patients' age ranged from 24 to 78 years and 52.9% were male. At ocular ultrasound, the mean tumor thickness and diameter were 6.3 mm and 11.5 mm, respectively. At initial MRI, most tumors presented high or intermediate signal at T1 (82.3%) and low signal at T2 (70.6%). Two patients (15.4%) showed signs of tumor progression during follow-up and a significant reduction in mean ADC values was observed between MR before and after treatment in these cases (p = 0.02). In conclusion, DW-MRI has shown to be useful in assessing patients with choroidal melanoma and mean ADC values can be used for response assessment, allowing early identification of patients at risk for progression after brachytherapy


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Brachytherapy , Diffusion Magnetic Resonance Imaging , Eye Neoplasms , Response Evaluation Criteria in Solid Tumors , Melanoma
SELECTION OF CITATIONS
SEARCH DETAIL